HOW WE TEACH Generalizable Education Research

Can Facebook pages be a mode of blended learning to supplement in-classteaching in Saudi Arabia?

Khurshid Anwar,1 Muhammad Raihan Sajid,1 Peter Cahusac,2 Abdul Ahad Shaikh,3 Ahmad Elgammal,4

Ahlam Alshedoukhy,1 and Junaid Kashir5,6,7

1Department of Pathology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 2Department of Pharmacology &Biostatistics, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 3Department of Physiology, College ofMedicine, Alfaisal University, Riyadh, Saudi Arabia; 4College of Medicine, Alfaisal University, Riyadh, Saudi Arabia;5Department of Anatomy & Genetics, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 6Department ofComparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; and 7School ofBiosciences, Cardiff University, Cardiff, United Kingdom

Submitted 10 May 2017; accepted in final form 19 June 2017

Anwar K, Sajid MR, Cahusac P, Shaikh AA, Elgammal A,Alshedoukhy A, Kashir J. Can Facebook pages be a mode of blendedlearning to supplement in-class teaching in Saudi Arabia? Adv PhysiolEduc 41: 472–477, 2017; doi:10.1152/advan.00065.2017.—The aim ofthis study was to examine the potential of a self-designed Facebookpage on Neuroscience, to supplement in-class teaching as a modeof blended learning. Posts were split into multiple choice questions(MCQs), general interest articles, neuroscience-related externallinks and resources, and lecture notes and PowerPoint presenta-tions. The study was divided into three distinct phases: before,during, and after the Neuroscience block. Student responses wereevaluated via a self-developed questionnaire. Grades achieved bystudents undertaking the block in 2015 and 2014 were recorded, aswere the grades achieved by the same cohort in concurrent blocksin the same year of study. Results showed that ~80% of studentsreported that use of the page enhanced their overall subjectknowledge and exam preparation. Highest page activity occurredduring the Neuroscience block. Peak activity occurred directlybefore summative assessments, with MCQ posts having the highestimpact. The cohort of students with access to the Facebook pageachieved better grades in the block compared with the previouscohort, despite similar average performance in other subjects. Wedemonstrate the utility of Facebook as a powerful tool for under-graduate education, supplementing in-class teaching, and assistingin exam preparation, potentially increasing average student perfor-mance.

blended learning; Facebook; neuroscience; phobia; physiology

THE BACHELOR OF MEDICINE, Bachelor of Surgery (MBBS)program at the College of Medicine at Alfaisal Universityfollows a problem-based, self-directed, 3-yr undergraduatecurriculum, followed by 2 yr of clerkship and 1 yr ofinternship. Problem-based learning (PBL) is integrated withappropriate clinical skills training and community-basedexperiences (5). Alfaisal University also employs team-based learning (TBL) as a core instructional strategy in thefirst year of the medical school. The College of Medicineemploys an integrated hybrid undergraduate curriculum,

where a “spiral” approach of education is employed. Mod-ules in years 1–3 are system-based “blocks,” incorporatinga focus on pathophysiological mechanisms with verticalintegration of clinical subjects (13). One of the blocks inyear 2 is Neuroscience (NEU), which, in particular, is adifficult subject in undergraduate medicine, with phobiasassociated with its study among medical students (2, 18). Aprerequisite of being able to undertake the NEU block is tohave passed all blocks in the first year of study.

E-learning teaching methodology employs web-based tech-nologies to enhance knowledge and performance, offeringlearners control over content, sequence, pace of learning, time,and media (4, 6, 8, 9). Most studies exploring the use ofe-learning are based on learning management systems, such asBlackboard and Moodle. Recently, social networking websites,including Twitter and Facebook, have become a mainstreamform of interaction, spanning almost every age, career, andsocioeconomic interest group. Such forums are being utilizedfor endeavors ranging from philanthropic initiatives to raisinghealthcare awareness (9). Facebook pages concerning variousmedical conditions, including forms of cancer, hypertension,and diabetes, already exist, with a credible number of users,including patients and their families, researchers, and clinicians(4, 11).

However, the utility of social networking sites as a consis-tent means of learning in undergraduate medical curricularemains a prospect that is much underinvestigated. The mostpopular social media site is currently arguably Facebook,encompassing 1.44 billion monthly and 936 million dailyactive users (14, 16). Indeed, �90% of medical students spenda considerable amount of time using Facebook on a daily basis(7, 8). Few studies exist that explore the utility of Facebook asa modality for blended learning to supplement traditionalundergraduate medical education and the potential of suchplatforms to overcome physical barriers to teaching and pro-viding content that is easily accessible and promotes interac-tivity (6, 7).

To examine the utility of employing social networkingplatforms as a blended learning aid in the undergraduatecurriculum, we developed a Facebook page supplementingdidactic classroom lectures, incorporating e-learning mate-

Address for reprint requests and other correspondence: M. R. Sajid, Dept. ofPathology, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh11533, Saudi Arabia (e-mail: msajid@alfaisal.edu).

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rial, including general quizzes, multiple choice questions(MCQs), online lectures, and external reference material.The present study aimed to evaluate the effectiveness of thisFacebook page as an e-learning tool for undergraduatemedical students.

MATERIALS AND METHODS

Brief curriculum and block description. Running over 10 wk duringthe second year of undergraduate study, the NEU block at Alfaisal isfully integrated, covering anatomy and physiology of the central andperipheral nervous systems, alongside applied concepts and diseaseprocesses. An additional clinical skills program runs concurrently.Block contents are delivered through multiple formats, includinglectures, PBL sessions, tutorials, laboratory sessions, and clinicalskills sessions. Other blocks of study during the second year of studyinclude Endocrine and Reproductive, Head and Neck, Basic Pathol-ogy and Microbiology, and Skin blocks.

We regularly use Moodle as a learning management system atAlfaisal University. However, to assess and evaluate the utility ofFacebook as a supplementary teaching resource, our designed Face-book page was kept separate from Moodle.

Page design. A Facebook page was developed, supplementingclassroom learning objectives for students undertaking the NEUblock, termed “Interactive Neuroscience” (1). The types of posts madewere split into four general categories: MCQs, general interest articles(covering topics not directly related to neurosciences), neuroscience-related external links and resources (covering topics directly related toneurosciences, such as external links to research articles and studyresources), and lecture notes and PowerPoint material (includinglecture PowerPoint slides and tutor notes). Posted MCQs were relatedto the various topics covered in the NEU block, which students wereinvited to answer and comment on. Correct answers with a briefexplanation were posted on the page after 24–48 h. Student partici-pation was voluntary and ungraded, and students were allowed to postcontent under moderation by the page manager.

Response evaluation. Student responses to the Interactive Neuro-science page were evaluated via student feedback using a self-developed questionnaire. The questionnaire (see APPENDIX) was up-loaded onto surveymonkey.com, and the link emailed to students. Thedata were filled anonymously, and, on completion, the data wereretrieved and analyzed using Microsoft Excel. A total of 14 questionswere asked, in addition to 3 questions regarding age, sex, and year ofstudy. The questionnaire focused on evaluating student perceptionregarding the aforementioned pages, assessing student access fre-quency, efficacy in complementing student access to performance inPBL, comprehension of didactic teaching, and preparation for sum-mative examinations.

We also employed the “Insights” tool from Facebook to accesspage metrics, including page likes and reach, student engagement,demographic data, and post reach. Tracking such metrics allowed usto effectively track the number of active users in relation to pageperformance (10). Post impact (i.e., response to particular post type inrelation to the number of such posts) was determined by calculatingthe ratio of post reach and number of posts. The course of our studywas divided into three distinct phases: before the NEU block (pre-NEU; November 1, 2014 to January 15, 2015), during the NEU block(during NEU; January 25 to April 12, 2015), and after the NEU block(post-NEU; April 13 to June 15, 2015). Data obtained from theFacebook Insight tool were correlated to these phases, and correla-tions were made between page activity and occurrence of summativeassessments.

Student performance evaluation. Grades achieved by students un-dertaking the NEU block in 2015 were recorded, as were the gradesachieved by the same cohort in concurrent blocks in the same year ofstudy. Concurrently, similar grades achieved by the previous cohort ofstudents (2014) for the same blocks were also extracted for compar-

ison (i.e., grades obtained by the class of 2015 were compared withthose obtained by the class of 2014).

RESULTS

Page reach. Collectively, the Interactive Neurosciencespage was widely accessed, exhibiting significant activity interms of weekly average engaged users (98), weekly averagetotal reach (510), weekly average total impressions (10,438),and weekly average reach of page posts (462). The total reachof this page at the end point of our study was 1,035 people,comprising 58% women and 42% men. There were a total of667 “likes,” with 84% from the 18- to 24-yr-old age group,followed by 10% from the 25-to 34-yr-old age group, over 2 yr.Global access and distribution exhibited page access from atotal of 45 cities and 39 countries worldwide.

Student feedback. Students reported continuous access rang-ing from 1 to �24 wk, with an average of 9 wk for 47% ofstudents. Almost 15% of students reported accessing pages ona daily basis, whereas another 22% accessed the pages morethan once or twice on a weekly basis. Around 58% of studentsalso reported visiting other online resources apart from thedesigned Facebook page. Only five students reported technicaldifficulties in accessing material posted on these pages. Ap-proximately 63% of students reported using the page to down-load PowerPoint presentations and notes relating to lectures.MCQs was a popular category, with �78% of students report-ing access. About 74% accessed the posted educational websitelinks, including announcements relating to lectures and clini-copathological correlation sessions posted on these pages.

Almost 80% of students felt using Interactive Neurosciencesenhanced their knowledge and understanding of lectures, tuto-rials, and laboratory sessions. However, only 39% felt thatsuch material helped them in PBL sessions. Around 76% ofstudents felt that the Facebook pages enhanced their criticalcapability in understanding neuroscience and their ability toanswer exam questions. Nearly 81% of students acknowledgedthat visiting these webpages enhanced their overall knowledge.

Facebook insight metrics. Comparison of the period before,during, and after the NEU block indicated a peak in reach andinterest correlating to block activities, with maximal numbersof people accessing the page just before the formative andsummative assessment components of the block. The threemain summative assessment components of the NEU blockwere two TBL activities and the final exam, all three of whichcorrelated directly to the three highest peaks in total reachobserved in our entire study period (reaches of 299, 292, and377, respectively), with the highest peak of the entire studyperiod observed directly before the final exam (Fig. 1). It isalso apparent that maximal activity in terms of total reach ofoverall posts on the Interactive Neurosciences page occurredduring the NEU block at Alfaisal University, increasing sig-nificantly in comparison to before the block started. After theblock had ended, activity fell slightly, on average, but re-mained considerably higher compared with the pre-NEU pe-riod.

Analysis of data relating to individual post impact revealedthat the highest impact was made by the MCQ category ofposts, followed by general interest posts. This was followed byneuroscience-related external links and resources, with lecture-related notes and PowerPoint material having the least impact.

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We found that the post impact of all categories apart fromMCQs remained relatively consistent throughout all threephases of our study, with general interest posts increasingslightly in impact in the post-NEU phase. Lecture and Power-Point material impact increased slightly in the during-NEUphase compared with the pre-NEU phase and had no impact inthe post-NEU phase, as no such posts were made. Intriguingly,MCQs were consistently accessed with the highest impact inall three phases of our study, with a very sharp increase in postimpact observed in the during-NEU phase (Fig. 2).

Student grade analysis. Students undertaking the NEU blockin the 2015 cohort (n � 197), who had access to the Facebookpage, performed considerably better in terms of gradesachieved compared with the previous (2014) cohort (n � 160).Collectively, while the proportion of failing students (grade F)was only slightly lower (8.2% compared with 8.5%), theproportion of students achieving grades A–C was dramaticallyhigh in the 2015 cohort (22.9, 28.5, and 20.4% respectively)compared with the 2014 cohort (10.3, 25, and 14.4%, respec-tively) (Fig. 3A).

A general comparison of student performance in each co-hort, indicated by comparison of the average grades obtained inthe rest of the year by students, indicated very minor differ-ences, with comparable levels of grades achieved (P � 0.05following the Student’s t-test). The proportion of studentsachieving grade A in 2015 (21.6%) was slightly lower com-pared with the 2014 cohort (23.9%), with slightly higherproportions of students achieving grades B and F in 2015 (41.1and 16%, respectively) compared with the 2014 cohort (40.1and 14.7%, respectively) (Fig. 3B).

A further analysis of student performance indicated thatstudents performed worse in the NEU block compared withother blocks in the same year for the 2014 cohort, with lowerproportions of students obtaining grades A (10.3 vs. 23.9%), B

TBL 1 TBL 2 Final Exam

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Time (days)Fig. 1. Histogram representing the total reach of overall posts on the “Interactive Neurosciences” Facebook page throughout the study period (November 1, 2014to June 15, 2015) conducted during the NEU block at Alfaisal University. This was further divided into periods defined as Pre-NEU (blue box), During NEU(red box), and Post-NEU (green box) periods. Both TBL sessions and the occurrence of the final exam are indicated with arrows. All three summative assessmentcomponents are directly preceded by maximal peaks in total reach observed throughout this study.

0 50 100 150Post impact (overall reach/number of posts)

Pre-NEU

During NEU

Post-NEU

Fig. 2. Histogram representing the comparative impact of post type related todistribution throughout our study period (November 1, 2014 to June 15, 2015)for the neurosciences (NEU) block at Alfaisal. This period is representedbefore the block began (Pre-NEU), during the block (During NEU), and afterthe completion of the block (Post-NEU). Post impact was calculated byobtaining the ratio between overall post reach and number of posts for eachpost type (i.e., MCQ; neuroscience-related external links and resources; gen-eral interest posts; and lecture/PowerPoint material).

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(25 vs. 40.1%), and C (14.4 vs. 20.8%). However, there werea lower number of failures (grade F; 8.5 vs. 14%) (Fig. 4A).Comparatively, however, students in the 2015 cohort per-formed considerably better in the NEU block in comparison tothe rest of the blocks in the year, with higher proportions ofstudents achieving grade A (23 vs. 21.6%) and B (48.5 vs.41.1%). The proportion of students achieving grade C re-mained comparable (20.4 vs. 20.8%), whereas the proportionof students achieving grade F fell (8.2 vs. 16%) (Fig. 4B).

DISCUSSION

Use of social networking sites, including Facebook, Skype,YouTube, WhatsApp, and Twitter, are now increasingly beingused for educational purposes (7, 15). Facebook is the mostpopular social media platform being used for social interactionand educational purposes (8, 9). Herein, we report the designand employment of a Interactive Neuroscience Facebook page.Care was taken to align the material being posted on these twopages with the themes of the week in our regular block. Ouranalysis indicated that, although educational items were beingaccessed, other supplementary items, including anecdotes, lifehacks, spiritual medicine-related articles, and other health-

related material increased the interest of site visitors, makingpage appeal more universal.

Published reviews on the utility of Facebook in teachinghave failed to identify any study examining the applicability ofsocial media in undergraduate medical student summativeexamination outcome (15). Our results indicated that studentsgenerally accepted the usefulness of these pages in helpingthem prepare for their summative examinations. Indeed, this isconsistent with our observation that access and reach of bothpages peaked just before the assessment components of theblocks. The three highest peaks of activity were observed justbefore the three major summative assessment activities in theblock (TBL sessions and the final exam). This further corre-lates with our findings that MCQs exerted the highest impact inall three phases of our study, with a large increase in postimpact during the NEU block.

Our experience demonstrates that Facebook is no longeronly a platform for social interaction, but can also be utilizedfor educational purposes with custom-built information pro-vided to students. This enhances and complements their in-class learning in a safe and interactive environment, with nodependence on time constraints. A further advantage of devel-

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Fig. 4. Histogram representing the comparative grades achieved between therest of the blocks occurring in the year (shaded bars) and the NEU block (solidbars) in 2014 (A) and 2015 (B) at Alfaisal University. The histogram shows theproportion of students achieving the stated grades (A, B, C, and F).

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oping Facebook pages is that group membership is not re-quired, making this a free platform for interaction and learning.Students are able to choose and access material privately,minimizing elements of peer pressure, in stark contrast to anin-class environment, where shy students may refrain frominteraction during lectures or small-group activities, such asPBLs or TBL.

To the best of our knowledge, our present study is the firstto examine the utility of such novel teaching methodology inNeurosciences. Indeed, a literature search did not reveal anysuch published studies. This is particularly relevant, as it iswell accepted that students are generally averse to Neurosci-ences. Our present study indicated that supplementation ofdidactic teaching with Facebook teaching helped alleviate thisphobia, at least as far as student perception was concerned,consistent with our present observations (2).

Analysis of student performance in terms of grades achievedindicated that students were performing better in the NEUblock compared with other blocks during the rest of the year inthe 2015 cohort, and also performed better in general comparedwith the 2014 cohort. As a general comparison of cohortcompetence, we found that student performance during the restof the year (excluding grades achieved in the NEU block) wasmore or less comparable in both 2014 and 2015 cohorts.However, we found implantation of our Facebook page in the2015 cohort improved grades achieved, with a higher propor-tion of students obtaining grades A–C, particularly those stu-dents obtaining grade B. Indeed, it is a commonly held notionin medical education that the number of high and low achievers(i.e., students obtaining grades A and F) will most likely notchange their outcome, regardless of teaching methodologyemployed. Thus it is essential to target the population ofstudents who remain on the cusp of good grades, i.e., to try andincrease the number of students getting a B and decreasingstudents getting C and F. Our results suggest that our Facebookpage is assisting in doing just that, increasing the number ofgrades A and B obtained by the 2015 cohort in comparison tothe last year.

Student interaction can be grouped into two categories.When commenting on the MCQs, students either venturedanswers alone, or answered questions with explanations. Theseexplanations were posted beneath each MCQ, and were themajor pathway by which concept clarification occurred. Theother category related to general comments and likes/dislikeswhich aided page administrators to modulate page contentaccordingly, which was also applicable to lecture and Power-Point material, alongside other general posts. It should also benoted that while MCQs were indeed the highest accessedmaterial, other material such as general interest items andexternal links were also accessed to a fair degree.

Finally, as the contents of these pages are in the publicdomain, the only limit to access is internet availability. TheFacebook Insights tool provides us with statistics aiding inmeasuring page growth and audience. These data are onlyavailable to page administrators and not to visitors. MostFacebook pages utilize these data for marketing purposes. Oneof the most important parameters that page administratorsshould examine is “engaged users” and impressions of posts,parameters previously demonstrated to be important (7, 9).However, a key consideration is that Facebook constantlyupdates and/or improves the algorithms by which insight met-

rics are determined. Authors attempting to perform similaranalyses should thus consider the time scales within which theywould perform similar analyses.

Conclusions. This study demonstrates that developmentand implementation of the Interactive Neurosciences Face-book page in the NEU block was received favorably bystudents, providing motivation and engagement of studentsin a variety of activities, supplementing their in-class teach-ing and clarifying core concepts. Multiple choice items weremost popular among students, delivering a platform toassess their knowledge, and providing assistance in prepa-ration for summative assessments. Indeed, we found evi-dence that such activities had a profound impact in increas-ing average student performance in summative assessment.However, while large differences were observed in gradesachieved following implementation of our Facebook page,we were unable to perform analyses to confirm the statisticalpower of such increase due to the limited cohort numbersreported herein (2014 and 2015).

We conclude that implementation of our Facebook page wasmost likely a very useful resource for students to use inknowledge consolidation and exam preparation, in a mannerthat is conveniently accessed by students in a pressure-freeenvironment. It is thus essential that such studies are nowexpanded to a wider range of subject material in the under-graduate medical curriculum and to a wider number of studentcohorts, with respective controls to examine effectiveness ofsuch resources.

APPENDIX

Survey for the Utility of Facebook Page

Year:

• Year 2• Year 3

Sex:

• Male• Female

Nationality:Age:Do you access any other educational interactive site?

• Yes• No

1. Interactive NeuroscienceDid you access this page?

• Yes• No

How long have you been accessing this page? Please circle one.

• 1–4 wk• 5–8 wk• 9–12 wk• 13–24 wk• �24 wk

How frequently do you access this page? Please circle one.

• More than once daily• Once daily• Once or twice weekly

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• Fortnightly• Monthly• Rarely

Have you encountered technical difficulties accessing these pages?

• Yes• No

Have you used this page to download or view PowerPoint presen-tations and notes connected with lectures?

• Yes• No

Have you used this page to access the daily posted MCQs?

• Yes• No

Have you answered MCQs posted on this page?

• Yes• No

Have you tried to access links posted on this page (links do notinclude MCQs and lectures)?

• Yes• No

Have you accessed announcements regarding lectures and clinico-pathological correlation?

• Yes• No

Has using the page enhanced your knowledge and understanding ofthe lectures, tutorials, and practicals?

• Yes• No

Has using the page enhanced your capabilities in participating inPBL discussion?

• Yes• No

Has using the page enhanced your capability in answering examquestions?

• Yes• No

Has using the page enhanced your critical capability in understand-ing pathology?

• Yes• No

Does this page provide useful links to other web-based learningresources?

• Yes• No

Do you think this page has overall improved your knowledge?

• Yes• No

DISCLOSURES

No conflicts of interest, financial or otherwise, are declared by the author(s).

AUTHOR CONTRIBUTIONS

K.A., M.R.S., A.A.S., and A.A. conceived and designed research; K.A.,M.R.S., and A.E. performed experiments; K.A., M.R.S., P.M.B.C., A.A.S.,A.E., A.A., and J.K. analyzed data; K.A., M.R.S., P.M.B.C., A.A.S., A.A., andJ.K. interpreted results of experiments; K.A., M.R.S., P.M.B.C., and J.K.prepared figures; K.A., M.R.S., and J.K. drafted manuscript; K.A., M.R.S.,A.A.S., A.A., and J.K. edited and revised manuscript; K.A., M.R.S., P.M.B.C.,A.A.S., A.E., A.A., and J.K. approved final version of manuscript.

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